Impact of prior fragility fracture on patient's mortality, outcomes, and complications after hip fracture surgery.

BACKGROUND

Osteoporosis, a common metabolic bone condition primarily affecting geriatrics globally, weakens bones and raises fracture risk. Prior osteoporotic fractures heighten susceptibility to further fractures, notably hip fractures, impacting outcomes post-surgical management. Analyzing this link is vital for optimizing interventions for at-risk individuals. This study investigates these associations and suggests interventions for high-risk patients.

METHODS

This study is a retrospective case-control analysis of 1234 patients who underwent hip fracture surgery. Hospital records from two teaching university hospitals and two major governmental hospitals in Jordan over a three-year period were reviewed. Data encompassed patient demographics, comorbidities, perioperative variables, and postoperative outcomes and complications.

RESULTS

Of the 1234 patients, 124 (10%) had prior fragility fractures (PFF): 85 contralateral hip (68.5%), 25 distal radius (20.2%), and 18 proximal humerus fractures (14.5%). Patients with prior contralateral hip fractures had higher rates of hypertension (55.5% vs. 41.1%, p = 0.03) and dementia (3.5% vs. 2.1%, p = 0.09), with trends in diabetes (38.8% vs. 31.3%, p = 0.17) and ICU admissions (7.0% vs. 4.3%, p = 0.33) that were not statistically significant. Blood transfusion rates were comparable (35.3% vs. 33.4%, p = 0.82). Subgroup analysis showed that patients with prior proximal humerus fractures had significantly higher postoperative strong analgesic use (60.5% vs. 43.2%, p = 0.007) and increased rates of dementia compared to other subgroups. However, these findings were specific to this subgroup and cannot be generalized to all PFF patients. The one-year all-cause mortality rate was 10.6% for patients with PFF and 6.2% for those without (p = 0.22). Although not statistically significant, this trend may hold clinical relevance in understanding the prognosis of this high-risk subgroup.

CONCLUSION

patients with prior contralateral hip fractures exhibited higher chances of postoperative ICU admission and increased comorbidity rates. This highlights the necessity for tailored care for this subgroup.

LEVEL OF EVIDENCE: Level III, Retrospective cohort study.